TABLE OF CONTENTS
Paragraph and Subject Date Trans. No.
Table of Contents . . . . . . 08/15 15-04
1 Purpose and Scope . . . . . . 08/15 15-04
2 Provisions of EEOICPA . . . . 08/15 15-04
1. Purpose and Scope. This chapter summarizes the provisions and requirements of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or Act) and addresses its coverage.
2. Provisions of EEOICPA.
a. Requirements for Part B Eligibility. A covered employee must satisfy criteria of eligibility for at least one of the following compensable categories under Part B:
(1) Beryllium sensitivity or chronic beryllium disease resulting from exposure to beryllium in the performance of duty.
(2) A specified cancer if the employee was a member of the Special Exposure Cohort (SEC).
(3) A non-specified cancer if the employee incurred a cancer that is at least as likely as not related to radiation exposure from employment at a covered facility.
(4) Chronic silicosis resulting from exposure to silica from covered employment at a Department of Energy (DOE) facility in Nevada or Alaska, aggregating at least 250 work days during the mining of tunnels for tests or experiments related to atomic weapons.
(5) The U.S. Attorney General has determined entitlement to an award of $100,000 under Section 5 of the Radiation Exposure Compensation Act (RECA).
b. Requirements for Part E Eligibility. A covered employee must establish that it is at least as likely as not that exposure to a toxic substance at a DOE facility was a significant factor in aggravating, contributing to, or causing the illness, and that it is at least as likely as not that the exposure to such toxic substance was related to employment at a DOE facility.
c. Medical Care. An employee who meets the statutory conditions of coverage is entitled to medical care consisting of services, appliances, and supplies prescribed or recommended by a qualified physician considered likely to cure, give relief, or reduce the degree or the period of that condition, and which DEEOIC considers likely to cure, give relief, or reduce the degree or the period of that illness. Provider charges associated with the treatment of an accepted medical condition are paid from the compensation fund and are subject to a fee schedule.
d. Monetary Compensation under Part B. An eligible employee or survivor is entitled to receive a lump sum payment of $150,000, if found eligible under Part B of the EEOICPA. An eligible uranium worker or survivor is eligible for a lump sum payment of $50,000.
e. Monetary Compensation under Part E. Maximum compensation up to $250,000 is determined based on causation, wage-loss, and impairment.
(1) Employee Benefits: Covered employee is eligible for compensation up to $250,000 based on wage-loss and/or impairment.
(a) Wage-loss is based on the number of calendar years that the employee sustained a reduction in wages as a result of the covered illness. Wage-loss compensation is payable for qualifying years occurring prior to the employee’s normal Social Security retirement age, determined by the employee’s date of birth.
(b) Impairment is a loss, loss of use, or derangement of any body part, organ system or organ functionality as it affects the whole body, as a result of the covered illness. An impairment rating is performed once the employee has reached Maximum Medical Improvement (MMI) (i.e., the covered illness is stabilized and is unlikely to improve with or without additional medical treatment).
(2) Survivor Benefits: The survivor is eligible for compensation in the amount of up to $125,000 if the covered illness aggravated, contributed to, or caused the employee’s death.
(a) Wage-Loss: The survivor may be entitled up to an additional $25,000 or $50,000 depending upon the amount of calendar years over 10 years that the deceased covered employee experienced compensable wage-loss prior to his or her normal Social Security retirement age.
(b) Impairment: In general, the survivor is not entitled to impairment benefits under Part E.
f. Survivor Eligibility under Part B. In the event of the death of an eligible employee, the Act provides for the disbursement of compensation in order of precedence and in proportion to the number of eligible survivors. The order of precedence is spouse, child, parent, grandchild, then grandparent.
g. Survivor Eligibility under Part E. The only survivors eligible for benefits are the spouse, or children of the covered employee who are under the age of 18 years at the time of the employee’s death, or under the age of 23 years and a full time student at the time of the employee’s death, or any age and incapable of self-support at the time of the employee’s death. In limited circumstances, a spouse may elect to receive the compensation to which an employee would have been eligible prior to death.
h. Third Party Liability. With the exceptions listed below, where an employee's compensable illness or death results from circumstances creating a legal liability on some party other than the United States, the cost of compensation and other benefits paid by the OWCP must be offset to reflect any settlement obtained. Exceptions include the following:
(1) Workers’ compensation benefits are not offset under Part B; and
(2) Insurance policy payments made to an employee or eligible surviving beneficiary, where the employee or eligible surviving beneficiary has purchased the policy, are not offset.
i. Coordination of Benefits with State Workers’ Compensation (SWC). When a claimant has received benefits from a state workers’ compensation program for the same covered illness(es) to which he or she is to be awarded compensation under Part E, this requires a reduction in the award. Exceptions to this reduction include the following:
(1) Medical and vocational rehabilitation benefits received from SWC for the same covered illness(es) are not included in the reduction;
(2) The claimant has received SWC benefits for both a covered and a non-covered illness as a result of the same-work related incident; these benefits also will not be included in the reduction; and
(3) Reasonable costs in obtaining SWC benefits incurred by the claimant, such as but not limited to attorney’s fees and specific itemized costs of suits, are not included in the reduction.